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To develop an approach for creating facility-specific urinary antibiograms accounting for the low number of isolates recovered in nursing homes (NHs).
Design:
Retrospective analysis of urine culture data collected in NHs in five states.
Setting:
Data on 5097 urine culture isolates collected across 59 study NHs from January 1, 2020 to December 31, 2021. Four consulting microbiology laboratories served the study homes.
Methods:
We compared a Clinical and Laboratory Standards Institute (CLSI) standard antibiogram model to four weighted-incidence syndromic antibiogram (WISCA) models utilizing alternate formatting rules. Ability to produce a facility-specific antibiogram with at least 30 isolates and the impact on susceptibility predictions were compared.
Results:
Only one facility could generate a CLSI standard antibiogram for the three most commonly recovered Gram-negative isolates over a one-year period. Ability to generate an antibiogram increased with each of the four WISCA models trialed (36%, 54%, 85%, 85%) with the most successful models combining all Gram-negative isolates over a two-year period. Shortening the definition of duplicate isolates from 12 to 3 months did not improve performance. Using all Gram-negative isolates, rather than the three most recovered pathogens, resulted in meaningful changes in the predicted activity of ampicillin-sulbactam, cefazolin, ceftriaxone, and trimethoprim-sulfamethoxazole in several study NHs.
Conclusions:
These results suggest that WISCAs using 2-years of urinary culture data including all gram-negative isolates and excluding duplicate isolates within twelve months maximizes the number of NHs able to create a valid antibiogram.
Urban–rural divides are large and growing in many national elections, but the sources of this widening divide are not well understood. Recent research has pointed to policy disagreement as one possible mechanism for this growing divide; if urban and rural residents hold increasingly dissimilar policy preferences, this disagreement could produce ever‐widening urban–rural electoral divides. We investigate this possibility by creating a synthesized dataset of nearly 1000 policy issue questions across 10 distinct Canadian national election studies conducted between 1993 and 2021 (N = 5.3 million), combined with a measure of the urban or rural character of every federal electoral district. This dataset allows us to measure urban–rural policy disagreement across a much larger range of policy issues and over a much longer time period than has previously been possible. We find strong evidence of urban–rural policy disagreement across a range of issues, and especially in areas of cultural policy, including questions relating to gun control, immigration and Indigenous affairs. We further find strong support for the ‘progressive cities’ hypothesis; in nearly all policy domains, urban residents support more left‐wing positions on policy issues than rural residents. However, we find no evidence these urban–rural policy divides have grown since the 1990s. Urban–rural policy disagreement, while large and meaningful, cannot explain the ever‐widening urban–rural political divide.
While some 40 per cent of the students undertaking political science degrees in the UK are women, about three-quarters of those teaching them are men. This article examines why female undergraduates are less likely to go into graduate work in politics, utilising focus groups conducted with groups of male and female students and interviews with the female students in four large UK universities. The research identifies eight key factors that impacted upon our respondents' decisions to undertake further study. The first four affected both men and women, although there were subtle, yet important, differences in how the women spoke about these issues, and can be somewhat loosely categorised as: money; making a difference; lack of information; and self-confidence. The other four factors influenced the women's, but not the men's, views about graduate work and the profession: stereotyping; role models; family commitments, and time constraints. On the basis of our research, we suggest how national political science associations and individual departments might increase the number of women undertaking graduate work.
This chapter offers an overview of Antarctica’s major meteorological and climate features using the latest methods, data products, and research findings. The first half of the chapter presents a thorough description of the Antarctic geography and its climatological temperature, precipitation, and near-surface environment. It provides a dedicated section covering Antarctic foehn and foehn-induced warming, which have been identified as major ‘hot spots’ for Antarctic surface melt and ice shelf destabilisation. Next the chapter details the major large-scale and regional atmospheric circulation patterns that characterise the high southern latitudes and strongly influence Antarctic meteorology, including the Southern Annular Mode, teleconnections associated with the El Niño Southern Oscillation, and the Amundsen Sea Low. We then present the latest research discoveries on Antarctic climate extremes, with a focus on Antarctic ‘atmospheric rivers’ and their role in driving extreme temperature, precipitation, and surface melt events. The chapter closes with a summary of recent Antarctic climate change, current research gaps and challenges, and recommendations for future work.
Clozapine is licensed for treatment-resistant schizophrenia (TRS). Because of the risk of clozapine-induced agranulocytosis, its use requires regular haematological monitoring. Substantive evidence supports revisions of absolute neutrophil counts (ANCs) for clozapine discontinuation and ceasing of indefinite haematological monitoring.
Aims
To examine the cost-effectiveness and budget impact of different haematological monitoring schemes compared with the current UK monitoring practice for patients using clozapine.
Method
We performed a cost-effectiveness and budget impact analysis from the healthcare system perspective over a 3-year period, comparing the current UK clozapine monitoring practice with extended haematological monitoring and a revision of ANC criteria. Costs and quality-adjusted life years (QALYs) were estimated using a semi-Markov model that followed a simulated cohort of 100 000 adults with TRS. Sensitivity analyses were conducted.
Results
Extended haematological monitoring would lead to lower mean total costs per patient (6388.34 v. 5569.77 GBP) and not compromise quality of life (in QALYs 795.83 v. 795.79 days). A revision of ANC criteria for clozapine discontinuation would not substantially lower costs (6388.34 v. 6390 GBP), but lead to a slight increase in QALYs (795.83 v. 797.08 days), through patients benefitting from longer clozapine treatment. A combination of extended haematological monitoring and revision of ANC criteria would be the dominant strategy, which means that costs are lower (6388.34 v. 5548.50 GBP) and QALYs slightly increase (795.83 v. 797.03 days) compared with the current UK monitoring practice.
Conclusions
A revision of current UK clozapine monitoring practice would be beneficial from both a clinical and an economic perspective. Adjusting ANC criteria for clozapine cessation avoids unnecessary early discontinuation of clozapine treatment and has a positive impact on quality of life. An extension of monitoring intervals reduces costs borne by the healthcare system. Safety is not compromised by these changes.
One of the most incredible aspects of the Mexican Baja Peninsula is the immense wealth of plant and animal diversity it holds. The human communities living alongside this richness have boundless intimate knowledge of its natural history, potentially with novel insights into the ecological and evolutionary processes shaping the diversity of plants and animals. These same human communities have likely also witnessed changes to these natural environments over their lifetimes, particularly as the effects of global change are being felt by similar rural communities around the world. However, because the area is so remote, they often have little access to scientific data or current information about the causes or effects of the changes they observe. Using a thematic analysis of recorded conversations, this project seeks to connect remote rural ranches in Mexico with scientists, to gather data on the issues that matter most to the community members, and work to find collaborative solutions. Through thematic analysis of recorded conversations, our research reveals that unpredictable climate variability, including droughts, hurricanes, and shifting seasonal patterns, poses significant challenges to ranching livelihoods. Ranchers’ deep ecological knowledge provides critical insights into the stresses of changing and increasingly unpredictable environmental trends. By integrating local perspectives with scientific approaches, this study highlights the potential for collaborative biodiversity research.
The Hector Galaxy Survey is a new optical integral field spectroscopy (IFS) survey currently using the Anglo-Australian Telescope to observe up to 15 000 galaxies at low redshift ($z \lt 0.1$). The Hector instrument employs 21 optical fibre bundles feeding into two double-beam spectrographs, AAOmega and the new Spector spectrograph, to enable wide-field multi-object IFS observations of galaxies. To efficiently process the survey data, we adopt the data reduction pipeline developed for the SAMI Galaxy Survey, with significant updates to accommodate Hector’s dual-spectrograph system. These enhancements address key differences in spectral resolution and other instrumental characteristics relative to SAMI and are specifically optimised for Hector’s unique configuration. We introduce a two-dimensional arc fitting approach that reduces the root-mean-square (RMS) velocity scatter by a factor of 1.2–3.4 compared to fitting arc lines independently for each fibre. The pipeline also incorporates detailed modelling of chromatic optical distortion in the wide-field corrector, to account for wavelength-dependent spatial shifts across the focal plane. We assess data quality through a series of validation tests, including wavelength solution accuracy (1.2–2.7 km s$^{-1}$ RMS), spectral resolution (FWHM of 1.2–1.4 Å for Spector), throughput characterisation, astrometric precision ($\lesssim$ 0.03 arcsec median offset), sky subtraction residuals (1–1.6% median continuum residual), and flux calibration stability (4% systematic offset when compared to Legacy Survey fluxes). We demonstrate that Hector delivers high-fidelity, science-ready datasets, supporting robust measurements of galaxy kinematics, stellar populations, and emission-line properties and provide examples. Additionally, we address systematic uncertainties identified during the data processing and propose future improvements to enhance the precision and reliability of upcoming data releases. This work establishes a robust data reduction framework for Hector, delivering high-quality data products that support a broad range of extragalactic studies.
Clozapine remains underused despite its unparalleled efficacy in treatment-refractory schizophrenia. One of the reasons for its underuse is the fear of severe neutropenia and its consequences.
Aims
To scrutinise the association between severe neutropenia and clozapine in a cohort of patients clinically diagnosed with clozapine-induced severe neutropenia.
Method
We used data from the South London and Maudsley National Health Service Foundation Trust’s anonymised case register, known as the Clinical Record Interactive Search. We extracted details of cases where clozapine use was associated with two consecutive neutrophil counts below 1.5 × 109/L. A panel of clinicians independently assessed each case. Agreement was reached on which cases clozapine was the likely or definite cause of the severe neutropenia, the risk to life and whether or not rechallenge with clozapine could be attempted.
Results
There were 96 cases where two consecutive neutrophil counts below 1.5 × 109/L were registered. The panel judged that 9 (9.4%) were definitely caused by clozapine and a further 11 (11.5%) were probably caused by clozapine. Overall, 18 (18.8%) patients should be precluded from ever receiving clozapine again according to the panel (all from the 20 cases where clozapine was the definite or probable cause). Of the remaining 76 cases of severe neutropenia the cause could not be determined in 60 cases, but in 11 cases the cause was benign ethnic neutropenia, in 2 others the cause was cancer chemotherapy, in 2 it was infections and in 1 it was laboratory error. In almost 80% of cases, clozapine was not the clear cause of the neutropenia observed.
Conclusions
The large majority of severe neutropenia episodes mandating cessation of clozapine may not be caused by clozapine. Threshold-based monitoring systems cause unnecessary stopping of clozapine because they lack the necessary specificity for clozapine-related blood disorders.
Point-of-care technologies (POCTs) have grown increasingly prevalent in clinical and at-home settings, offering various rapid diagnostic capabilities. This study presents findings from a nationwide survey conducted between November 2023 and January 2024, capturing clinician perceptions of POCTs.
Methods:
The survey was distributed via email to healthcare professionals through academic and industry listservs and through LinkedIn posts. A total of 159 responses were analyzed.
Results:
Core priorities, including accuracy, ease of use, and availability, remain consistently valued over the years. However, several perceived benefits, including continuous patient monitoring, diagnostic certainty, and patient management exhibited significant declines in agreement compared to previous years. Despite this, clinician perceptions of POCTs’ abilities to enhance patient–provider communication remained stable. Evolving concerns may reflect heightened expectations and greater scrutiny as these technologies become commonplace. Agreement that POCTs may undermine clinical expertise increases, while concerns related to reimbursement and usability decline. Pilot questions related to artificial intelligence (AI) and machine learning (ML) indicated moderate openness to adopting AI-enhanced POCTs, particularly with tools offering novel clinical insights.
Conclusions:
While POCTs continue to be an asset in clinical settings, the findings of this study suggest a shift in provider attitudes toward a more neutral standpoint. Limitations include a low response rate, self-selection, and missing demographic data from a subset of participants. Future surveys will further integrate AI/ML-related questions while prioritizing broader demographic and geographic reach.
While evidence-based clinical practice guidelines promote high-quality care, their absence may create unwarranted variation in disease management, leading to suboptimal outcomes. This study aimed to identify existing clinical practice guidelines for tardive dyskinesia (TD) in France, Germany, Italy, Spain, and the United Kingdom (EU4+UK), assessing the evidence for recommended TD treatments.
Methods
MEDLINE, PubMed, and other sources (e.g., government/public agencies, associations, patient/research organizations) were searched to identify clinical practice guidelines for TD published between January 2000 and February 2025 in EU4+UK. Mentions of TD treatments in identified documents were classified as “recommendations” or “descriptions.” Recommendations were ranked according to the Scottish Intercollegiate Guidelines Network grading system or received a “no-rank” label. Subanalyses on tetrabenazine and tiapride, were performed.
Results
Of the 31 documents identified, only two were TD-specific, with the remainder primarily developed for schizophrenia, major depressive disorder, and bipolar disorder. Data extraction led to 112 mentions of TD treatments (40 recommendations, 72 descriptions). Most recommendations focused on antipsychotic regimen modification (75%) and had no rank (88%). Only five recommendations (no rank) proposed a pharmaceutical (add-on) treatment: three for tetrabenazine and one each for amantadine and buspirone. Neither of the TD-specific guidelines contained TD treatment recommendations.
Conclusions
No specific clinical practice guidelines for TD in EU4 + UK were found, although TD management was mentioned in guidelines for other disorders. Most recommendations were not supported by high-quality evidence. To improve quality of care for patients with TD in Europe, updated treatment recommendations are needed based on high-quality studies.
The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.
Methods:
Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017–6/2018 and Spread was 5/2019–9/2019. The Pioneer intervention phase was 7/2018–7/2021 and Spread 10/2019–7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.
Results:
Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).
Conclusions:
This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.
Intensive longitudinal data (ILD) collected in mobile health (mHealth) studies contain rich information on the dynamics of multiple outcomes measured frequently over time. Motivated by an mHealth study in which participants self-report the intensity of many emotions multiple times per day, we describe a dynamic factor model that summarizes ILD as a low-dimensional, interpretable latent process. This model consists of (i) a measurement submodel—a factor model—that summarizes the multivariate longitudinal outcome as lower-dimensional latent variables and (ii) a structural submodel—an Ornstein–Uhlenbeck (OU) stochastic process—that captures the dynamics of the multivariate latent process in continuous time. We derive a closed-form likelihood for the marginal distribution of the outcome and the computationally-simpler sparse precision matrix for the OU process. We propose a block coordinate descent algorithm for estimation and use simulation studies to show that it has good statistical properties with ILD. Then, we use our method to analyze data from the mHealth study. We summarize the dynamics of 18 emotions using models with one, two, and three time-varying latent factors, which correspond to different behavioral science theories of emotions. We demonstrate how results can be interpreted to help improve behavioral science theories of momentary emotions, latent psychological states, and their dynamics.
The Australian SKA Pathfinder (ASKAP) offers powerful new capabilities for studying the polarised and magnetised Universe at radio wavelengths. In this paper, we introduce the Polarisation Sky Survey of the Universe’s Magnetism (POSSUM), a groundbreaking survey with three primary objectives: (1) to create a comprehensive Faraday rotation measure (RM) grid of up to one million compact extragalactic sources across the southern $\sim50$% of the sky (20,630 deg$^2$); (2) to map the intrinsic polarisation and RM properties of a wide range of discrete extragalactic and Galactic objects over the same area; and (3) to contribute interferometric data with excellent surface brightness sensitivity, which can be combined with single-dish data to study the diffuse Galactic interstellar medium. Observations for the full POSSUM survey commenced in May 2023 and are expected to conclude by mid-2028. POSSUM will achieve an RM grid density of around 30–50 RMs per square degree with a median measurement uncertainty of $\sim$1 rad m$^{-2}$. The survey operates primarily over a frequency range of 800–1088 MHz, with an angular resolution of 20” and a typical RMS sensitivity in Stokes Q or U of 18 $\mu$Jy beam$^{-1}$. Additionally, the survey will be supplemented by similar observations covering 1296–1440 MHz over 38% of the sky. POSSUM will enable the discovery and detailed investigation of magnetised phenomena in a wide range of cosmic environments, including the intergalactic medium and cosmic web, galaxy clusters and groups, active galactic nuclei and radio galaxies, the Magellanic System and other nearby galaxies, galaxy halos and the circumgalactic medium, and the magnetic structure of the Milky Way across a very wide range of scales, as well as the interplay between these components. This paper reviews the current science case developed by the POSSUM Collaboration and provides an overview of POSSUM’s observations, data processing, outputs, and its complementarity with other radio and multi-wavelength surveys, including future work with the SKA.
The use of explosive weapons in populated areas (EWIPA) has a disproportionate impact on civilians. Many humanitarian organizations utilize varying sheltering guidelines to recommend safe positions for civilians affected by explosive threats. It is not known whether these recommendations are standardized or derived from evidence. This study aimed to identify existing recommendations and potential gaps in literature relevant to sheltering guidelines for civilians during explosive events.
Methods
A scoping review was conducted of the literature including indexed databases and grey literature to identify reports that described sheltering guidelines for civilians during explosive events. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology was followed.
Results
The search identified 3582 peer-reviewed records. After title/abstract and full text screening, only 2 peer-reviewed reports remained eligible. These were combined with 13 gray literature reports obtained from humanitarian organizations and internet searches. The peer-reviewed reports included mine and unexploded ordnance guidelines, not guidelines for EWIPA or aerial bombardments. There is a substantial knowledge gap and heterogeneity in existing sheltering guidelines from explosive events, particularly those appropriate for protection from EWIPA.
Conclusions
Findings from this scoping review demonstrate a need for the creation and standardization of evidence-based civilian sheltering guidelines to mitigate the threat of explosive weapons to civilians in conflict.
This study uses established procedures to estimate the effects of changes in mortality and growth implant protocols on feedlot net returns (NRs). We then propose new methods for estimating concurrent impacts to feedlot greenhouse gas emissions intensity. Reducing mortality consistently increases NRs and reduces greenhouse gas emissions intensity in the feedlot regardless of sex or placement weight. Results indicate that use of two implants in the feedlot may increase NRs and reduce greenhouse gas emissions per pound of dressed beef produced, compared to just one growth implant.
Objectives/Goals: To assess theory of mind and empathy in adolescents with Tourette syndrome (TS) and examine their association with social problems. This study aims to extend research in social cognition to an adolescent cohort with TS and identify a potential modifiable risk factor for social problems in TS that may serve as a novel intervention target. Methods/Study Population: We will enroll 50 adolescents with TS (ages 11–17) and 50 demographically matched controls along with one parent to complete a single in-person study visit. Adolescents with TS will be recruited through the Vanderbilt Center for TS and other Tic disorders. Controls will be recruited using university listservs and flyers posted in community and primary care settings. Adolescents will complete the NEPSY-II to assess theory of mind abilities and the Multifaceted Empathy Test – Juvenile to assess empathy with negative emotions. Parents will complete the Child Behavior Checklist to assess adolescent social problems. Results/Anticipated Results: Based on evidence of low self-other distinction in TS, we hypothesize TS adolescents will make more errors about the mental states of others (theory of mind) and report greater emotional reactions to faces (empathy) compared to controls. Further, greater social problems will be associated with greater disturbances in social cognition. To date, 15 adolescents with TS and 15 matched controls have completed the assessment (67% male; Mage = 14.33 in both groups). Within this sample, adolescents with TS experienced more social problems than controls (Cohen’s d = .74, p = .03). There were no between-group differences in theory of mind or empathy in this pilot sample. However, higher levels of both theory of mind and empathy were linked to experiencing greater social problems in the TS sample only (p’s < .05). Discussion/Significance of Impact: Preliminary findings suggest that while social cognition did not differ between groups, TS adolescents exhibiting high levels of theory of mind and empathy appear to struggle socially. This work could inform future interventions by highlighting the need to focus on social cognition and how these skills translate into social behaviors.
Objectives/Goals: Mayo Clinic Florida’s Clinical Research Units develop over 200 clinical studies on average annually. Almost 30% of these projects are developed and then are unable to activate due to a variety of operational factors. To increase the success rate, a scoring tool was created to assess the risk associated with the development of these research projects. Methods/Study Population: A project team comprised of members of research administration and physician leadership developed a rapid project management (RPM) scoring tool to assess operational risk factors. The scoring algorithm was embedded into an existing REDCap database, using a combination of identified variables and calculated fields. All noncancer industry sponsor-initiated clinical studies were scored at intake. According to the following categories: enrollment timelines, study team capacity, and previous experience with the Sponsor. Studies with a score greater than the established threshold were referred to physician leadership for transparent discussions with the principal investigator regarding the identified study development-related risks. Results/Anticipated Results: The RPM tool has assessed close to 200 projects since implementation in June 2022. An interim analysis is being conducted of all projects assessed by the RPM tool dating from implementation to May 2024 to compare the outcomes of these studies with the given RPM score. We anticipate based on anecdotal evidence gathered during the course of this pilot project that the RPM tool will show a correlation between risks identified and study outcomes as defined as successful activation of trials, or rationale of project development failures. We anticipate a reduction in the amount of time elapsed and effort expended developing projects with scores reflecting identified project development-related risk factors. Discussion/Significance of Impact: The RPM tool provides an opportunity to allocate resources to studies with the greatest potential for successful activation. In the future, the RPM tool may be used to identify risk factors associated with enrollment and accrual of participants.
Objectives/Goals: Imaging neuromas, benign tumors of nerve tissue, can be difficult in amputees with osseointegrated (OI) prostheses, in which a metal rod is implanted into the residual limb. Magnetic resonance imaging can be inadequate due to the implanted metal. The aim of this study is to assess the use of ultrasound to detect neuromas in patients with OI prostheses. Methods/Study Population: This is a single-institutional observational study of 7 patients undergoing lower limb OI prostheses. Lower extremity nerve ultrasounds with 2-D grayscale and Doppler were completed at postoperative follow-up visits following OI prosthesis implantation. Specifically, the sciatic nerve, tibial nerve, common peroneal nerve, and sural nerve were targeted for imaging. Neuromas found on ultrasound were measured by maximal length in three planes. Results/Anticipated Results: Our study to date includes two patients with OI prostheses. The remaining patients will be accrued by the end of December. The first patient with a left below-the-knee amputation completed imaging 3 years after OI prosthesis implantation. The common peroneal nerve showed preserved fascicular architecture and morphology, with no distinct neuroma formation. However, the sural nerve demonstrated a 6 × 5 × 4 mm neuroma with minimal pain with deep palpation. The tibial nerve demonstrated a 14 × 11 × 8 mm neuroma within the medial calf musculature, with mild pain with deep palpation. The second patient with a right above-the-knee amputation was imaged 10 months after OI prosthesis implantation. The sciatic nerve demonstrated preserved fascicular morphology and terminated in a smooth taper. There was no defined neuroma. Discussion/Significance of Impact: In conclusion, we have preliminarily shown in the first two patients that ultrasound can successfully image neuromas in patients with OI prostheses in the postoperative period. Furthermore, despite a patient that was 3 years postoperative with two neuromas, the neuromas produced minimal to mild pain with targeted palpation.
Many post-acute and long-term care settings (PALTCs) struggle to measure antibiotic use via the standard metric, days of therapy (DOT) per 1000 days of care (DOC). Our objective was to develop antibiotic use metrics more tailored to PALTCs.
Design:
Retrospective cohort study with a validation cohort.
Setting:
PALTC settings within the same network.
Methods:
We obtained census data and pharmacy dispensing data for 13 community PALTCs (January 2020–December 2023). We calculated antibiotic DOT/1000 DOC, DOT per unique residents, and antibiotic starts per unique residents, at monthly intervals for community PALTCs. The validation cohort was 135 Veterans Affairs Community Living Centers (VA CLCs). For community PALTCs only, we determined the DOT and antibiotics starts per unique residents cared for by individual prescribers.
Results:
For community PALTCs, the correlation between facility-level antibiotic DOT/1000 DOC and antibiotic DOT/unique residents and antibiotic courses/unique residents was 0.97 (P < 0.0001) and 0.84 (P < 0.0001), respectively. For VA CLCs, those values were 0.96 (P < 0.0001) and 0.85 (P < 0.0001), respectively. At community PALTCs, both novel metrics permitted assessment and comparison of antibiotic prescribing among practitioners.
Conclusion:
At the facility level, the novel metric antibiotic DOT/unique residents demonstrated strong correlation with the standard metric. In addition to supporting tracking and reporting of antibiotic use among PALTCs, antibiotic DOT/unique residents permits visualization of the antibiotic prescribing rates among individual practitioners, and thus peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC residents.